Ten-year follow-up of degenerative spinal lesions on radiographs and MRI in axial spondyloarthritis: results of the DESIR (DEvenir des spondylarthropathies indifférenciées récentes) cohort - Report - MDSpire
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Ten-year follow-up of degenerative spinal lesions on radiographs and MRI in axial spondyloarthritis: results of the DESIR (DEvenir des spondylarthropathies indifférenciées récentes) cohort
Long-term Degenerative Spinal Lesions in Axial Spondyloarthritis: DESIR Cohort 10-Year Study
Overview
This 10-year longitudinal study from the DESIR cohort evaluated degenerative spinal lesions (DLs) in young axial spondyloarthritis (axSpA) patients using radiographs and MRI. It found a high prevalence of DLs at baseline and documented their progression over time, highlighting factors associated with lesion evolution.
Background
Axial spondyloarthritis is a chronic inflammatory disease primarily affecting the spine, often assessed by radiography and MRI to detect inflammatory and structural changes. Degenerative spinal lesions are common in axSpA patients, with previous studies reporting prevalence rates up to 70-89% on MRI at baseline. Despite this, the long-term progression of DLs in axSpA remains poorly understood, and their evolution may impact diagnosis and management. Understanding DL progression is clinically important to avoid misinterpretation of imaging findings and optimize treatment strategies.
At baseline, spinal degenerative lesions were highly prevalent: approximately 30% on radiographs and over 70% on MRI.
DLs increased in number and severity over the 10-year follow-up period in young axSpA patients.
Different lesion types showed variable progression rates, with some lesions such as disc degeneration and facet joint osteoarthritis evolving more rapidly.
Progression of DLs was associated with factors including spinal ankylosis, syndesmophyte development, and facet joint fusion, which alter spinal biomechanics.
The presence and progression of DLs may delay axSpA diagnosis by nearly 3 years and complicate clinical management decisions.
Central readers blinded to clinical data reliably identified and scored DLs on imaging, supporting the robustness of lesion assessment.
Clinical Implications
Clinicians should be aware of the high prevalence and progression of degenerative spinal lesions in axSpA patients, as these may mimic or obscure inflammatory changes. Accurate differentiation between degenerative and inflammatory lesions on imaging is essential to avoid diagnostic delays and inappropriate treatment. Monitoring DL progression over time can inform prognosis and guide personalized management strategies to preserve spinal function.
Conclusion
This 10-year DESIR cohort study demonstrates that degenerative spinal lesions are common and progressively worsen in young axSpA patients, influenced by structural spinal changes. Recognizing and tracking these lesions is critical for accurate diagnosis and optimal long-term care.
by Laura Pina Vegas, Miranda van Lunteren, Damien Loeuille, Caroline Morizot, Esther Newsum, Sofia Ramiro, Floris van Gaalen, Alain Saraux, Pascal Claudepierre, Antoine Feydy, Désirée van der Heijde, Monique Reijnierse
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